Patients with GSD type I GSD are now doing well, and the prognosis for children and adults with these conditions is outstanding. In fact, at the University of Florida, 34 children have now been born to mothers with GSD. While there have been tremendous advances over the past 2 decades, acute metabolic decompensations can occur at any time, and a missed dose of cornstarch or interruption in a feed can result in severe hypoglycemia, seizures, or even death. As a result, the ultimate goal is to cure the disease, and the team at the University of Florida is working on bringing potentially curative gene therapy to people with the disease.
Gene Therapy in Dogs with GSD Ia: GSD type Ia occurs naturally in maltese dogs. Without treatment, all of the dogs die within hours of birth. Even with medical therapy, no dog with the disease had survived for more than 4 weeks when this work started. Gene therapy was performed on a dog with GSD type Ia (Dulce) in Florida for the first time on September 11, 2007. Within 2 weeks, the duration of fasting markedly increased, and visually the dog improved with decreased hepatomegaly, increased energy, and improved growth. The effect of gene therapy waned so a second gene therapy was performed in January 2008. Following this treatment on Dulce the lactate concentration normalized, and she was able to fast for 9 hours without development of hypoglycemia. All glucose support was stopped at 6 months of age, and Dulce had no problems clinically while weaning off therapy. A liver biopsy 6 months after the 2nd gene therapy dose demonstrated 7% activity. Dulce remained off of therapy for 19 months (21 months following the last gene therapy treatment), but elevated lactates subsequently developed when she went into heat. As a result, low dose therapy was restarted, and Dulce had a third gene therapy treatment in February 2010. As of 4 years of age, Dulce has had no adenomas or evidence of complications.
Tucker and Jasmine were born April 9, 2010. Gene therapy was performed at 36 hours of life using a modified vector, and the response was even more dramatic. By 2 weeks of age, puppies were able to fast for 6 hours (baseline 45-60 minutes), and glucose support discontinued at 3 weeks. A second gene therapy treatment was performed at 8 weeks, and the dogs are doing well at 20 months of age.
Gene Therapy in an Older Dog with GSD: Since most children and adults will be treated outside of the newborn period, it is critical to assess gene therapy in older dogs. This was first attempted in Ginger who was born in September 2010. Following birth, Ginger was medically treated for 2-1/2 months. Without the gene therapy, the dog struggled to maintain her blood sugars. She had poor growth and extreme metabolic instability. Due to her poor health, gene therapy was performed, and she clinically normalized after 1 week. Three more dogs with GSD (Colin, Casper, and Gemini) were born in June 2011, and they are receiving the same treatment as Ginger.
Future of Gene Therapy:
- Gene therapy appears to be a promising therapy for the future in GSD Ia
- Meetings with NIH and Duke have been occurring since January 2011 as we attempt to bring gene therapy to humans in a collaborative way.
- Gene therapy trial in humans with GSD II in Florida was commenced in March 2011
Mental Health Study
It is commonly known that chronic medical conditions can negatively impact mental health and well-being. Indeed, many individuals with chronic medical conditions report mental health symptoms, which are distressing and can interfere with medical adherence and physical health.
Unfortunately, research regarding mental health among individuals with glycogen storage disease is almost non-existent. Given the complex medical regimen, the treatment side effects, and the health consequences associated with GSD, mental health is a crucial area of study. Enhancing mental health treatment may lead to improved medical functioning and quality of life for patients and their families.
As a result, we have developed a study to examine the risks and consequences of mental health symptoms and disorders among individuals with GSD. Families with an individual aged 7 or older who has any type of GSD (types I through XII) are eligible for the study.
The entire study will take approximately 1 − 1.5 hours for individuals aged 7 − 12, and approximately 1.5 − 3 hours for individuals aged 13 and older. Participants will be asked to complete several questionnaires regarding mental health and GSD, as well as an interview. In addition, participants aged 13 and older will be asked to complete an assessment regarding substance use (e.g., medications, tobacco, alcohol, and other drugs).
- All research responses will be kept confidential by the Psychology team. No individual responses will be shared with the medical providers.
- Study participation can be arranged at a convenient time during your visit to the UF Glycogen Storage Disease Program. Participants will receive financial compensation for their time.
- For more information on research studies, contact the GSD Research Coordinator: Laurie Fiske 352-273-6655 or firstname.lastname@example.org.
Research supported by Joshua Adam Conrad Memorial Fund for GSD Research and other philanthropy.
Johnny Damon isn’t just a famous baseball player, he is a GSD philanthropist. Last year the Johnny Damon Foundation gave the Glycogen Storage Disease Program at the University of Florida money to support a research facility in the Faroe Islands. Located halfway between Denmark and Iceland, this isolated community with a population of 49,493 has the highest known incidence of GSD III in the world; one in every 22 people on the islands is a carrier. Dr. Weinstein became aware of the children with GSD III on the island in 2008 after meeting a German physician, Dr. Ulrike Steuerwald, who frequently went to the island to support patients. In collaboration, the physicians have been able to improve the care of children and adults with GSD III. During a visit to the Faroe Islands in 2012, a research satellite was created as a joint venture with the teams from the hospital in Torshavn, Dr. Steuerwald, and the UF GSD Program. The new research center is already evaluating the possible relationship between GSD genetics and co-morbidities including elevated cholesterol concentrations. Teresa Flanagan and Sara Siegal, research interns from the UF GSD Program, traveled to the new institute in October 2012 to help create genetic testing for GSD III on the islands. Future endeavors include testing new therapies for GSD III there. Arden Czyzewski, executive director of the Johnny Damon Foundation, remarked that, "For us, this donation was an opportunity to support research that could make a difference in the lives of children living with what can be a devastating disease without the right therapy.” Thank you Johnny!
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